The Role of Pelvic Floor Muscle Training on Low Anterior Resection Syndrome

Abstract

Background and Objective: Total mesorectal excision (TME) for rectal cancer (RC) often results in significant bowel symptoms, commonly known as low anterior resection syndrome (LARS). Although pelvic floor muscle training (PFMT) is recommended in noncancer populations for treating bowel symptoms, this has been scarcely investigated in RC patients. The objective was to investigate PFMT effectiveness on LARS in patients after TME for RC. Methods: A multicenter, single-blind prospective randomized controlled trial comparing PFMT (intervention; n = 50) versus no PFMT (control; n = 54) 1 month following TME/stoma closure was performed. The primary endpoint was the proportion of participants with an improvement in the LARS category at 4 months. Secondary outcomes were: continuous LARS scores, ColoRectal Functioning Outcome scores, Numeric Rating Scale scores, stool diary items, and Short Form 12 scores; all assessed at 1, 4, 6, and 12 months. Results: The proportion of participants with an improvement in LARS category was statistically higher after PFMT compared with controls at 4 months (38.3% vs 19.6%; P = 0.0415) and 6 months (47.8% vs 21.3%; P = 0.0091), but no longer at 12 months (40.0% vs 34.9%; P = 0.3897). Following secondary outcomes were significantly lower at 4 months: LARS scores (continuous, P = 0.0496), ColoRectal Functioning Outcome scores (P = 0.0369) and frequency of bowel movements (P = 0.0277), solid stool leakage (day, P = 0.0241; night, P = 0.0496) and the number of clusters (P = 0.0369), derived from the stool diary. No significant differences were found for the Numeric Rating Scale/quality of life scores. Conclusions: PFMT for bowel symptoms after TME resulted in lower proportions and faster recovery of bowel symptoms up to 6 months after surgery/stoma closure, justifying PFMT as an early, first-line treatment option for bowel symptoms after RC.

Pelvic floor muscle exercises alleviate symptoms and improve mental health and rectal function in patients with low anterior resection syndrome

“…Notably, these two studies employed retrospective designs. The latest study ( 23 ) found that the LARS scores, ColoRectal Functioning Outcome scores, and frequency of bowel movements of patients who underwent pelvic floor muscle training were significantly lower than those of a control group, which is a similar finding to that of our study.…”

Low anterior resection syndrome

“…55 The benefit was abrogated at 12 months and the authors advocated for early utilization of this therapy in patients with LARS after treatment for rectal cancer. 55 If persistent symptoms exist despite the interventions, consideration for placement of a sacral nerve stimulator may be undertaken. 50 Sacral nerve stimulators act via afferent nerves from the anorectum to reduce antegrade colonic motility and promote retrograde peristalsis of the neorectum.…”

“…53,54 Asnong et al evaluated the effectiveness of pelvic floor muscle training in a multicenter trial and found that patients reported LARS scores improved for several months after beginning training. 55 The benefit was abrogated at 12 months and the authors advocated for early utilization of this therapy in patients with LARS after treatment for rectal cancer. 55 If persistent symptoms exist despite the interventions, consideration for placement of a sacral nerve stimulator may be undertaken.…”

“…This modality has been shown to be effective to reduce fecal incontinence, stool frequency, and ultimately can improve quality of life 53,54 . Asnong et al evaluated the effectiveness of pelvic floor muscle training in a multicenter trial and found that patients reported LARS scores improved for several months after beginning training 55 . The benefit was abrogated at 12 months and the authors advocated for early utilization of this therapy in patients with LARS after treatment for rectal cancer 55 …”

Low anterior resection syndrome

“…We also performed a prospective study for verifying the effects of anal sphincter exercise, but it is still unclear how the biofeedback training differs from self‐training with how the Kegel maneuver differs 43 . A recent randomized trial investigated the effectiveness of the pelvic floor muscle training after rectal cancer surgery, but they revealed lower proportions and faster recovery of bowel symptoms in the pelvic floor muscle training group only up to 6 mo, and the effects did not last longer at 12 months 44 …”